Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees

<p>Abstract</p> <p>Background</p> <p>Prior studies have found that patients taking single-pill amlodipine/atorvastatin (SPAA) have greater likelihood of adherence at 6 months than those taking 2-pill calcium-channel blocker and statin combinations (CCB/statin). This study examines whether this adherence benefit results in fewer cardiovascular (CV) events.</p> <p>Methods</p> <p>A retrospective cohort study was conducted using administrative claims data from the IMS LifeLink: US Health Plan Claims database, identifying adults already taking CCB or statin (but not both) who had an index event of either initiating treatment with SPAA or adding CCB to statin (or vice versa) between April 1, 2004 to August 31, 2005. Inclusion criteria included age 18+ years, continuously enrolled for minimum of 6 months prior and 18 months following treatment initiation, >1 diagnosis of hypertension, and no prescription claims for SPAA or added CCB or statin for 6 months prior. Exclusion criteria included >1 claim with missing or invalid days supplied, age 65+ years and not enrolled in Medicare Advantage, or history of prior CV events, cancer diagnosis, or chronic renal failure. The primary outcome measure was the rate of CV events (myocardial infarction, heart failure, angina, other ischemic heart disease, stroke, peripheral vascular disease, or revascularization procedure) from 6 to 18 months following index date, analyzed at three levels: 1) all adherent vs. non-adherent patients, 2) SPAA vs. dual-pill patients (regardless of adherence level), and 3) adherent SPAA, adherent dual-pill, and non-adherent SPAA patients vs. non-adherent dual-pill patients.</p> <p>Results</p> <p>Of 1,537 SPAA patients, 56.5% were adherent at 6 months, compared with 21.4% of the 17,910 CCB/statin patients (p < 0.001). Logistic regression found SPAA patients more likely to be adherent (OR = 4.7, p < 0.001) than CCB/statin patients. In Cox proportional hazards models, being adherent to either regimen was associated with significantly lower risk of CV event (HR = 0.77, p = 0.003). A similar effect was seen for SPAA vs. CCB/statin patients (HR = 0.68, p = 0.02). In a combined model, the risk of CV events was significantly lower for adherent CCB/statin patients (HR = 0.79, p = 0.01) and adherent SPAA patients (HR = 0.61, p = 0.03) compared to non-adherent CCB/statin patients.</p> <p>Conclusions</p> <p>Patients receiving SPAA rather than a 2-pill CCB/statin regimen are more likely to be adherent. In turn, adherence to CCB and statin medications is associated with lower risk of CV events in primary prevention patients.</p

Mycophenolate mofetil in systemic sclerosis-associated interstitial lung disease

This study aimed to assess the effect of mofetil mycophenolate (MMF), an inhibitor of lymphocyte proliferation, on lung function and skin in patients with systemic sclerosis (SSc)-associated interstitial lung disease (SSc-ILD). In this retrospective study, we reviewed the medical files of 10 patients with SSc-ILD (eight females, 10 patients with diffuse SSc; mean age, 59.7 +/- 12.7 years; disease duration, 7.7 +/- 4.7 years). Patients were treated with MMF (2 g/day) for 12 months. Lung function tests and the modified Rodnan total skin score (mRTSS) were assessed at baseline and at 12 months. Results were analyzed by paired Student's t test. There was a significant increase in forced vital capacity and a nonsignificant increase in carbon monoxide diffusing capacity at 12 months in patients on MMF (p = 0.04 and 0.66, respectively). There was no effect on mRTSS. MMF stabilizes lung function of SSc-ILD after 12 months of treatment

Use of fixed-dose combinations in hypertension and cardiovascular disease prevention

This book provides a critical and comprehensive review of the methodologies available for measuring drug adherence in clinical practice, including those relying on emerging technologies. The authors discuss the risk factors of non-adherence and shed light on how to identify patients at risk of poor adherence. Drug therapies in chronic diseases rely heavily on the patient's adherence, since drugs that are not taken are ineffective and leave the patient at high risk of developing clinical complications. Given the absence of new drugs for the treatment of hypertension, drug adherence is particularly important in these patients to improve blood pressure control. The book further investigates a new aspect, namely the importance of drug adherence in clinical trials and studies and draws attention to the limits of developing drugs without significant information on drug adherence. Several chapters are dedicated to the importance of adherence in specific forms of hypertension, such as resistant hypertension, dyslipidemia and hypertension associated with cardiovascular risk. As experts confronted with drug adherence in their daily practice, the authors analyse the real effectiveness of several interventions aimed at improving drug adherence and put particular emphasis on the importance of an interdisciplinary approach involving nurses and pharmacists. The volume also includes a careful analysis of the health and economic impact of poor adherence. The book is aimed at physicians, pharmacists, students and all health professionals dealing not only with hypertension or dyslipidemia, but also with chronic asymptomatic diseases such as diabetes, HIV or chronic respiratory diseases